MA H4339

Requires all Massachusetts health insurers, including the Group Insurance Commission, Medicaid, commercial insurers, Blue Cross Blue Shield, and HMOs, to cover biomarker testing for diagnosis, treatment, management, or monitoring of diseases when supported by FDA approvals, CMS determinations, or nationally recognized clinical practice guidelines.

Defines biomarker testing broadly to include single-analyte tests, multi-plex panel tests, protein expression analysis, and whole exome, genome, and transcriptome sequencing of tissue, blood, or other biospecimens.

Mandates prior authorization decisions within 72 hours, or 24 hours if delay would pose significant health risk; requests not answered within required timeframes are automatically deemed approved.

Requires coverage to be provided in a manner that limits disruptions in care, including avoiding the need for multiple biopsies or biospecimen samples.

Obligates carriers to provide clear, readily accessible processes on their websites for patients and practitioners to request exceptions to coverage policies or appeal adverse utilization review determinations.